When provider and payer work together, everyone wins. By Marcia A. Maar, COC, CPC, CRC Clean, accurate provider documentation improves reimbursement. To demonstrate, consider the ideal reimbursement process: A patient comes in for an office visit or service. A provider documents the reason for the visit, which proves medical necessity for services provided on the ...
May 31st, 2017
Have you ever wondered how to approach a physician who you've only see once or twice in the office because they are busy with inpatients, nursing home patients, etc.? It may seem intimidating; but if you are tactful, you can communicate effectively and with confidence. Billing and coding errors by providers are common: from selecting incorrect evaluation and ...
Ambiguities in the 1995 documentation guidelines create uncertainty. Editor’s Note: After this article was written, a Medicare administrative contractor announced new definitions for “detailed” and “expanded poblem-focused.” See the May issue of Healthcare Business Monthly to learn more. Within the Centers for Medicare & Medicaid Services’ (CMS) 1995 Documentation Guidelines for Evaluation and ...
Failing to thoroughly document signs and symptoms, assessments, and treatments of chronic diseases creates a ripple effect of misfortune. First, all relevant codes are not captured; this leads to improper payment (not to mention, an injustice to the patient). The next thing you know, the claim fails a Risk Adjustment Data Validation (RADV) or Office ...
To assign an appropriate diagnosis related group (DRG), you must correctly identify present on admission (POA) indicators on all inpatient claims for services rendered in general acute care hospitals. This may be challenging if there are documentation deficiencies in the medical record. Here’s how to remedy those deficiencies. POA Review POA is defined as conditions ...